Impact of Hemoglobin-Based Transfusion Thresholds on Transfusion Volume and 30-day Mortality in VV-ECMO Patients: Muti-center data

초록

The optimal hemoglobin (Hb) threshold for red blood cell (RBC) transfusion during veno-venous extracorporeal membrane oxygenation (VV-ECMO) remains unclear. This multicenter retrospective study investigated the impact of Hb-based transfusion strategies on 30-day mortality and transfusion volume. Adult VV-ECMO patients with respiratory cause across six centers were included. Patients receiving ≥3 units/day were excluded, and those with no available Hb trigger documentation were also removed. Patients were stratified by their dominant transfusion threshold: <7 vs ≥7 g/dL and <8 vs ≥8 g/dL. Among 295 patients meeting inclusion criteria, 34 were classified as Hb <7 dominant and 261 as Hb ≥7 dominant. Mortality rates were 35% and 31%, respectively (p=0.794), with total RBC transfusion volumes of 171 and 1,279 units (p=0.846). For the Hb 8-based stratification, 119 patients were Hb <8 dominant and 176 were ≥8 dominant. Mortality rates were 34% vs 31% (p=0.687), while transfusion volumes were 700 vs 749 units, respectively. The difference in transfusion volume between Hb 8 groups was statistically significant (p=0.0036), despite no mortality difference. In conclusion, Hb threshold–based transfusion strategies in VV-ECMO patients did not significantly affect 30-day mortality. However, a higher Hb threshold (≥8 g/dL) was associated with significantly greater RBC exposure. These results support the potential safety of more restrictive transfusion approaches for optimal transfusion strategies in ECMO care.